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Good Health: An Ounce of Prevention is Worth a Pound of Cure |
We all want to live a long and happy life, free of illness and chronic health conditions – and we want the same for our family. While there is no way to guarantee life-long perfect health, there is a lot we can do to minimize health risks. SMU has a number of programs that can help us achieve good health, manage existing medical conditions, and catch medical issues early – BEFORE they become serious problems.
In this article, we will focus on the “Preventive Care” benefits
provided through the SMU PPO medical plans administered by Blue
Cross Blue Shield of Texas (BCBSTX). All of the PPO options have
very valuable Preventive Care benefits – valuable in terms of
keeping you and your family healthy, and in terms of limiting your
out-of-pocket expenses.
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The basic Preventive Care benefit pays up to $500 per year for annual routine physicals, medical screenings and immunizations for you and each of your enrolled dependents, if administered by a doctor or medical facility participating in the BCBSTX network.
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In addition to the $500 Preventive Care benefit, the PPOs also pay the entire cost of Mammogram, Colonoscopy and PSA (Prostate) screenings for you and your enrolled dependents, if administered by a doctor or medical facility participating in the BCBSTX network. This is a new benefit, introduced on January 1, 2008.
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These benefits are not subject to your annual deductible and you don’t have to pay the $25 office visit copayment.
How many chronic conditions such as diabetes or heart disease, or catastrophic events such as cancer or heart attack, could be prevented - or detected and treated in the early stages - if we all took advantage of annual physicals and recommended screenings? We will never have an exact answer to this question but when problems are found early, the chances for treatment and cure increase significantly.
SMU Human Resources recently reviewed a report regarding utilization of routine physicals and related screenings by SMU BCBSTX PPO participants in 2007. Following are some important highlights.
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Only 12% of participants received a preventive physical exam last year.
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Less than 50% of female participants over age 41 had a mammogram last year. Sadly, over 40 participants were treated for breast cancer.
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Less than 50% of female participants had a pap-smear last year, a test critical to the prevention or early detection of cervical cancer.
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Less than 20% of male participants over age 41 received a PSA (prostate) screening last year.
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The rate of immunizations for children up to five years of age was fairly positive (92%), but only 51% of children age 6-15 received recommended immunizations.
No one looks forward to going for an annual physical, but consider the alternatives. Put up with the minor inconvenience of doing this once a year (at little or no cost to you), or don’t, and put yourself at risk for potentially life-threatening medical problems. Call your doctor today and make an appointment – for yourself and your family. JUST DO IT.
SMU does not receive participant-specific medical information from our health care vendors. Due to federal privacy laws, personal health information cannot be shared with employers.
The SMU Preventive Care Guidelines provide detailed gender, age and frequency guidelines for routine physical exams, medical screenings and immunizations.
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It is important that you talk to your doctor about family members (parents, grandparents, brothers, sisters, etc.) who have had breast, colon, prostate or other cancers. Your doctor also needs to know about family members who have had medical conditions such as diabetes, high blood pressure, high cholesterol, heart disease, etc.
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Keep in mind that these are recommended guidelines. The type and frequency of preventive medical screenings are determined by age, health and risk factors. For example, if your doctor feels that it is necessary to order a Mammogram, Colonoscopy or Prostate (PSA) screening earlier or more frequently than recommended in the Guidelines, the screening will still be paid in full, if administered by a doctor or medical facility participating in the BCBSTX network.
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To be sure that your preventive care claim is processed correctly, remind your doctor’s office staff to report the CPT Code for routine physicals/screenings/immunizations (including Mammogram, Colonoscopy and PSA screening) when they file your claim with BCBSTX.
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Be sure to bring a copy of the SMU Wellness Guidelines whenever you and your enrolled dependents go for your annual physical. Your doctor should order all screenings recommended for age and gender, as well as any other screenings he/she feels are medically necessary.
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